Variation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network.

<h4>Introduction</h4>WHO has recommended using Robson's Ten Group Classification System (TGCS) to monitor and analyze CD rates. Its failure to take some maternal and organizational factors into account, however, could limit the interpretation of CD rate comparisons, because it may c...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Thibaud Quibel, Patrick Rozenberg, Camille Bouyer, Jean Bouyer
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/887eec4ad6824a04b1dc71c5e140420f
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:887eec4ad6824a04b1dc71c5e140420f
record_format	dspace
spelling	oai:doaj.org-article:887eec4ad6824a04b1dc71c5e140420f2021-12-02T20:17:43ZVariation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network.1932-620310.1371/journal.pone.0251141https://doaj.org/article/887eec4ad6824a04b1dc71c5e140420f2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0251141https://doaj.org/toc/1932-6203<h4>Introduction</h4>WHO has recommended using Robson's Ten Group Classification System (TGCS) to monitor and analyze CD rates. Its failure to take some maternal and organizational factors into account, however, could limit the interpretation of CD rate comparisons, because it may contribute to variations in hospital CD rates.<h4>Objective</h4>To study the contribution of maternal socioeconomic and clinical characteristics and hospital organizational factors to the variation in CD rates when using Robson's ten-group classification system for CD rate comparisons.<h4>Methods</h4>This prospective, observational, population-based study included all deliveries at a gestational age > 24 weeks at the 10 hospitals of the French MYPA perinatal network in the Paris area. CD rates were calculated for each TGCS group in each hospital. Interhospital variations in these rates were investigated with hierarchical logistic regression models to quantify the variation explained by differences in patient and hospital characteristics when the TGCS is considered. Variations in CD rates between hospitals were estimated with median odds ratios (MOR) to express interhospital variance on the standard odds ratio scale. The percentage of variation explained by TGCS and maternal and hospital characteristics was also calculated.<h4>Results</h4>The global CD rate was 24.0% (interhospital range: 17-32%). CD rates within each TGCS group differed significantly between hospitals (P<0.001). CD was significantly associated with maternal age (>40 years), severe preeclampsia, and two organizational factors: hospital status (private maternities) and the deliveries per staff member per 24 hours. The MOR in the empty model was 1.27 and did not change after taking the TGCS into account. Adding maternal characteristics and hospital organizational factors lowered the MOR to 1.14 and reduced the variation between hospital CD rates by 70%.<h4>Conclusion</h4>Maternal characteristics and hospital factors are needed to address variation in CD rates among the TGCS groups. Therefore, comparisons of these rates that do not consider these factors should be interpreted carefully.Thibaud QuibelPatrick RozenbergCamille BouyerJean BouyerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0251141 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Thibaud Quibel Patrick Rozenberg Camille Bouyer Jean Bouyer Variation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network.
description	<h4>Introduction</h4>WHO has recommended using Robson's Ten Group Classification System (TGCS) to monitor and analyze CD rates. Its failure to take some maternal and organizational factors into account, however, could limit the interpretation of CD rate comparisons, because it may contribute to variations in hospital CD rates.<h4>Objective</h4>To study the contribution of maternal socioeconomic and clinical characteristics and hospital organizational factors to the variation in CD rates when using Robson's ten-group classification system for CD rate comparisons.<h4>Methods</h4>This prospective, observational, population-based study included all deliveries at a gestational age > 24 weeks at the 10 hospitals of the French MYPA perinatal network in the Paris area. CD rates were calculated for each TGCS group in each hospital. Interhospital variations in these rates were investigated with hierarchical logistic regression models to quantify the variation explained by differences in patient and hospital characteristics when the TGCS is considered. Variations in CD rates between hospitals were estimated with median odds ratios (MOR) to express interhospital variance on the standard odds ratio scale. The percentage of variation explained by TGCS and maternal and hospital characteristics was also calculated.<h4>Results</h4>The global CD rate was 24.0% (interhospital range: 17-32%). CD rates within each TGCS group differed significantly between hospitals (P<0.001). CD was significantly associated with maternal age (>40 years), severe preeclampsia, and two organizational factors: hospital status (private maternities) and the deliveries per staff member per 24 hours. The MOR in the empty model was 1.27 and did not change after taking the TGCS into account. Adding maternal characteristics and hospital organizational factors lowered the MOR to 1.14 and reduced the variation between hospital CD rates by 70%.<h4>Conclusion</h4>Maternal characteristics and hospital factors are needed to address variation in CD rates among the TGCS groups. Therefore, comparisons of these rates that do not consider these factors should be interpreted carefully.
format	article
author	Thibaud Quibel Patrick Rozenberg Camille Bouyer Jean Bouyer
author_facet	Thibaud Quibel Patrick Rozenberg Camille Bouyer Jean Bouyer
author_sort	Thibaud Quibel
title	Variation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network.
title_short	Variation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network.
title_full	Variation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network.
title_fullStr	Variation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network.
title_full_unstemmed	Variation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network.
title_sort	variation between hospital caesarean delivery rates when robson's classification is considered: an observational study from a french perinatal network.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/887eec4ad6824a04b1dc71c5e140420f
work_keys_str_mv	AT thibaudquibel variationbetweenhospitalcaesareandeliveryrateswhenrobsonsclassificationisconsideredanobservationalstudyfromafrenchperinatalnetwork AT patrickrozenberg variationbetweenhospitalcaesareandeliveryrateswhenrobsonsclassificationisconsideredanobservationalstudyfromafrenchperinatalnetwork AT camillebouyer variationbetweenhospitalcaesareandeliveryrateswhenrobsonsclassificationisconsideredanobservationalstudyfromafrenchperinatalnetwork AT jeanbouyer variationbetweenhospitalcaesareandeliveryrateswhenrobsonsclassificationisconsideredanobservationalstudyfromafrenchperinatalnetwork
_version_	1718374355145064448

Variation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network.

Ejemplares similares